Millions for Defense: Not a Dime for Tribute

Staged Accident Eliminates Coverage

In a no-fault auto insurance matter brought in New York, State Farm Fire and Casualty Company, as the plaintiff insurer established prima facie entitlement to summary judgment by:

submitting the examination under oath transcript of defendant insured Lesie Merle, in which she testified that she primarily garaged the car involved in the accident in Far Rockaway, New York, rather than in Connecticut;
the affidavit of its underwriter Christina Ardito, who establishes that such misrepresentation to plaintiff of the car's location was material.

In State Farm Fire And Casualty Company v. Lesie Merle, Katie Dieubon, Brittani Watson, Yolaunda Vaughn, Affinity Rx Inc, All County, LLC, Amsc, LLC, Benessere Services Inc, Honest Acupuncture P.C., Integrated Interventional Pain Management P.C., Khawaja Asim Siddique, M.D., Lite Care Rehab Pt P.C., Macintosh Medical, P.C., Medical Mri P.C., Noam Kurtis Md P.C., Patient Chiropractic, P.C., And Wind Physical Therapy P.C., Index No. 153004/2021, MOTION SEQ. No. 002, 2023 NY Slip Op 31281(U), Supreme Court, New York County (April 19, 2023) the trial court found in favor of State Farm.

FACTS

Plaintiff established that defendant Brittani Watson failed to appear for an examination under oath ("EUO") pursuant to the terms of the policy. The failure of an injured person to appear for an ["EUO"] is a defense to any claim for benefits by that person or their assignors.

State Farm established through claim specialist Richa Sinha who attested EUO testimony led it to conclude that the accident had been staged. This prima facie established plaintiff's right to deny claims arising from the accident.

DECISIONS

Accordingly, it was ORDERED that:

the plaintiff's motion for summary judgment was granted;
defendant Lesie Merle's cross-motion to vacate the default judgment entered against her was denied;
plaintiff is not obligated to provide any coverage, reimbursements, or pay any monies, sums, or funds to any of the answering defendants herein for any and all no-fault related services for which claims and/or bills have been, or may in the future be, submitted by the answering defendants to plaintiff;
The answering defendants lack standing to seek or recover no-fault, uninsured/underinsured and property damage benefits and/or claims submitted by or on behalf of BRITTANI WATSON as she breached a condition precedent to coverage by failing to appear for an examination under oath in connection with the claim that gave rise to the above-captioned lawsuit;
that the answering defendants lack standing to seek or receive No-Fault reimbursements for any bill submitted by or on behalf of LESIE MERLE, as she perpetrated a scheme to defraud and/or fraudulently procure a policy of insurance from plaintiff by knowingly submitting an application for insurance that contained material misrepresentations of fact and false and/or fraudulent statements;
that the alleged motor vehicle accident of November 26, 2019, which gave rise to the above-captioned lawsuit, was not the product of a covered event as defined by the applicable policy of insurance issued by plaintiff since the incident of November 26, 2019, was the product of a staged and/or intentional event;

plaintiff, by reason of no coverage and since the alleged accident of November 26, 2019 was the product of a staged and/or intentional event, is not required to pay any sums, monies, damages, awards and/or benefits to any of the appearing Defendants, their agents, employees, assignors and/or heirs arising out of any current or future proceedings, all uninsured/underinsured motorists lawsuits and arbitrations, arbitrations and lawsuits seeking to recover no-fault benefits, third-party lawsuits and arbitrations, and all claims for property damage arising out of the alleged accident of November 26, 2019.
ZALMA OPINION

State Farm refused to be cowed by a suit seeking benefits for a fraudulent, staged auto accident, and a fraudulently obtained policy of insurance, and defeated the multiple claims created as part of the fraud scheme. Every insurer should emulate State Farm and thoroughly investigate each claim and, when fraud is suspected, collect the necessary evidence and refuse to pay and be willing to litigate the issue.

(c) 2023 Barry Zalma & ClaimSchool, Inc.

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